Background and Purpose: The surgical treatment of Cubital Tunnel Syndrome still hasunsatisfactory results due mainly to arteriovenous ischemia of the nerve in the Epitrochlear Canal. The purpose of our biological procedure is to restore the vascularization of the nerve, transposed together with its vascular pedicle anteriorly to epicondyle, to immediately reactivate the axonal conduction of the Ulnar Nerve and thereby improve clinical results. Methods: From 1987 to 2022, a vascularized Anteposition was performed on 87 limbs for UlnarNerve Entrapment Syndrome at the elbow in 82 patients. Results: Fifty-seven Patients returned for follow-up, 52 Patients obtained excellent and good resultsand effective recovery of sensibility and muscular activity; the electromyographic examination showed many positive changes in the SCV and MCV with increased nerve conduction velocity. Patients with fair results (5 Patients) showed worthwhile recovery of the hand but they recorded many sensory and motor disturbances already present before the operation, even if more attenuated. Conclusions: Our surgical technique of Vascularised Anteposition of the Ulnar Nerve at the Elbowis able to resolve the mechanical aspect of the chronic neuritis of the Ulnar Nerve at the Elbow but also (preserving its vascularity) the biological aspect of its nutrition. The procedure, allowing effective, quick recovery of hand function in most of the patients of our Study-an improvement in all of them-is a step forward in the treatment of this disease.
Background: Kidney transplantation is the best treatment of end-stage kidney disease. The aim of this study was to evaluate the effect of Graft Body Weight Ratio (GBWR) on creatinine levels after living donor kidney transplantation. Methods: Between January 2018 and January 2019 at Medipol University Medical Faculty Hospital Organ Transplantation Department, Istanbul, Turkey, 26 patient’s in living donor kidney transplantation graft body weight ratio evaluated were studied retrospectively. In these patients were divided into two groups; Group 1: GBWR < 3 gram/kilogram (g/kg). Group 2: GBWR >3 gram/kilogram (g/kg). Between these two groups, demographic features, clinical features and creatinine levels were compared. Results: The mean age was 37.4±16.7 years. 16 (61.5 %) patients were male and 10 (38.5 %) patients were female. 10 (38.5 %) patients were GBWR < 3 g/kg and 16 (61.5 %) patients were GBWR >3 g/kg. The mean GBWR were 2.6±0.18 g/kg in GBWR < 3 g/kg group, 4.5±0.74 g/kg in GBWR > 3 g/kg group. Mean follow-up was 15.4±1.2 months. First month creatinine levels and sixth months creatinine levels were statistically significantly high in the GBWR < 3 g/kg group (p<0.05). Conclusions: Creatinine levels, appear to be high in the GBWR < 3 g/kg group after living donor kidney transplantation. Low GBWR should be remembered in patients with high creatinine levels.
The authors report three cases of stercoral peritonitis secondary to colon perforation in a context of chronic constipation. Two patients were young and under ant motility drugs and one patient was elderly and bedridden. The diagnosis was made in the first two patients, who presented with signs and symptoms of generalized peritonitis by the CT scan whereas the last patient presented with a septic shock that did not allow performing of a diagnostic imaging. All the three patients underwent an emergency laparotomy. Perforation sites were located on the sigmoid colon in the two young patients and on the transverse colon in the elderly patient. The two young patients underwent a Hartmann’s procedure while the elderly patient had a transverse colostomy. The latter patient died postoperatively due to late intervention.
Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Surgery HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Surgery journal
Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Surgery HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2022 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Surgery journal
CONTEXT:Of the 200 million adults worldwide who undergo noncardiac surgery each year, more than 1 million will die within 30 days.OBJECTIVE:To determine the relationship between the peak fourth-generation troponin T (TnT) measurement in the first 3 days after noncardiac surgery and 30-day mortality.DESIGN, SETTING, AND PARTICIPANTS:A prospective, international cohort study that enrolled patients from August 6, 2007, to January 11, 2011. Eligible patients were aged 45 years and older and required at least an overnight hospital admission after having noncardiac surgery.MAIN OUTCOME MEASURES:Patients' TnT levels were measured 6 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We undertook Cox regression analysis in which the dependent variable was mortality until 30 days after surgery, and the independent variables included 24 preoperative variables. We repeated this analysis, adding the peak TnT measurement during the first 3 postoperative days as an independent variable and used a minimum P value approach to determine if there were TnT thresholds that independently altered patients' risk of death.RESULTS:A total of 15 133 patients were included in this study. The 30-day mortality rate was 1.9% (95% CI, 1.7%-2.1%). Multivariable analysis demonstrated that peak TnT values of at least 0.02 ng/mL, occurring in 11.6% of patients, were associated with higher 30-day mortality compared with the reference group (peak TnT≤0.01 ng/mL): peak TnT of 0.02 ng/mL (adjusted hazard ratio [aHR], 2.41; 95% CI, 1.33-3.77); 0.03 to 0.29 ng/mL (aHR, 5.00; 95% CI, 3.72-6.76); and 0.30 ng/mL or greater (aHR, 10.48; 95% CI, 6.25-16.62). Patients with a peak TnT value of 0.01 ng/mL or less, 0.02, 0.03-0.29, and 0.30 or greater had 30-day mortality rates of 1.0%, 4.0%, 9.3%, and 16.9%, respectively. Peak TnT measurement added incremental prognostic value to discriminate those likely to die within 30 days for the model with peak TnT measurement vs without (C index = 0.85 vs 0.81; difference, 0.4; 95% CI, 0.2-0.5; P < .001 for difference between C index values). The net reclassification improvement with TnT was 25.0% (P < .001).CONCLUSIONS:Among patients undergoing noncardiac surgery, the peak postoperative TnT measurement during the first 3 days after surgery was significantly associated with 30-day mortality.
Ethnic disparities in pain assessment and analgesic administration following surgery have received little attention in the surgery literature. We noted that our Native American patients were less likely than others to complain of pain. A retrospective chart review of 21 Native American patients and a control group who underwent outpatient, elective laparoscopic cholecystectomy was performed. Native American patients had a statistically lower numeric pain score (mean, 6.5; 95% CI, 3.6-9.4) than non-Native American patients (mean, 8.1; 95% CI, 6.3-9.9; t38 = 2.63; P < .05). Native American patients also received less postsurgical analgesic (mean, 7.4; 95% CI, 4.0-10.8) than non-Native American patients (mean, 11.2; 95% CI, 7.2-15.2; t38 = 3.07; P < .01). Medical staff attending Native American patients should be aware that response to some scales to assess pain may not reflect accurately the degree of pain experienced.
Background The risk factors for anastomotic leak (AL) after anterior resection have been evaluated in several studies and remain controversial as the findings are often inconsistent or inconclusive. Objective To analyze the risk factors for AL after anterior resection in patients with rectal cancer. Design Retrospective analysis. Setting The Nationwide Inpatient Sample 2006 to 2009. Patients A total of 72 055 patients with rectal cancer who underwent elective anterior resection. Main Outcome Measures To build a predictive model for AL using demographic characteristics and preadmission comorbidities, the lasso algorithm for logistic regression was used to select variables most predictive of AL. Results The AL rate was 13.68%. The AL group had higher mortality vs the non-AL group (1.78% vs 0.74%). Hospital length of stay and cost were significantly higher in the AL group. Laparoscopic and open resections with a diverting stoma had a higher incidence of AL than those without a stoma (15.97% vs 13.25%). Multivariate analysis revealed that weight loss and malnutrition, fluid and electrolyte disorders, male sex, and stoma placement were associated with a higher risk of AL. The use of laparoscopy was associated with a lower risk of AL. Postoperative ileus, wound infection, respiratory/renal failure, urinary tract infection, pneumonia, deep vein thrombosis, and myocardial infarction were independently associated with AL. Conclusions Anastomotic leak after anterior resection increased mortality rates and health care costs. Weight loss and malnutrition, fluid and electrolyte disorders, male sex, and stoma placement independently increased the risk of leak. Laparoscopy independently decreased the risk of leak. Further studies are needed to delineate the significance of these findings.
